Adventitial cystic disease of the popliteal artery is a rare condition of uncertain etiology. A 32-year-old sportsman had sudden claudication in the left leg. Arteriography demonstrated smooth narrowing of the left popliteal artery. Treatment consisted of surgical removal of the cyst and patch angioplasty. He had no signs of recurrence at one year after treatment. Now, he enjoys sports again.

Since 2000 we have used a home-visit nursing program for fifth-year medical students at Gifu University to examine the significance of domiciliary and geriatric medicine. We used questionnaires before and after the program to evaluate its effects on students. The desire of students to be involved with both domiciliary and geriatric medicine as phys iciansincreased after the program. Greater increases were observed among students who knew less before the program about the significance of home and elder care. The program was effective for encouraging medical students to think about domiciliary and geriatric medicine.

The rate of mortality from paraquat poisoning is high and the principal manifestation of toxicosis is pulmonary impairment.
In this study, we measured the concentration of paraquat in the urine, blood, and some organs in 10 patients with acute paraquat poisoning in order to study the relationships of the kinetics in the body to the concentration in the lungs and to the pulmonary impairment.
The concentration of paraquat dichloride in the blood stream rapidly decreased in the first 24 hours. The half life was about 0.5 hour, within 2 hours (case 3) after intoxication, about 1 hour after 5 hours (case 5), about 2 hours after 10 hours (case 6) and after 24 hours (case 6) was prolonged to over 26 hours.
Therefore, it was suggested that half life was subsequently prolonged with the passage of time.
There were indications that renal disturbance appeared in about 5 hours after oral intake.
Accumulations of paraquat were seen in the organs examined. The largest amount within 24 hours after exposure was recognized in the lungs, and the largest amount after 271 hours was seen in the skeletal muscle. The concentration of paraquat in the lungs was higher than the concentration levels in the blood at death in all the cases.
Although excretion of paraquat from the lungs was very slow. it became faster with DHP and HD. However, excretion from the skeletal muscle was slow, Excretion from the other organs excepting the kidney was considered to be constant, being proportional to the blood concentration levels.
The pathologic examination of the lungs found congestive edema in 6 cases, which became severer with the lapse of time. Partial pulmonary fibrosis was recognized only in long-term survival cases.
The cause of irreversible pulmonary impairment was considered to be the effect of the small amount of paraquat remaining in the lungs which exceeds the concentration in the blood.

Studies have shown that postoperative disseminated intravascular coagulopathy (DIC) occurs in some patients with cardiac disease, acute aortic dissection, and ruptured abdominal aortic aneurysm. The specific pathophysiology of DIC in these settings are related to low cardiac function, shock, infection and sepsis as well as activation of coagulation cascade in the aneurysm sac or dissected aorta. A soluble form of recombinant human thrombomodulin (rhsTM) was approved in 2008 for the treatment of DIC. This report describes the safety and efficacy of rhsTM for the treatment of DIC in patients with cardiovascular disease operated in our department. Between October 2010 and March 2012, 35 patients with postoperative DIC were treated with rhsTM. Diagnosis of DIC was based on the diagnostic criteria for DIC of the Japanese Association for Acute Medicine (JAAM). During the first 6 months of the study period, after a diagnosis of DIC was made, the patients were treated with gabexate mesilate and antithrombin III, and if patients showed no improvement with conventional treatment, they received rhsTM for 6 days. During the last 10 months of the study period, patients received rhsTM soon after a diagnosis of DIC was made. Twenty seven patients survived for 28 days after rhsTM treatment, and the mortality rate was 22.9% (8/35). Patients who survived showed improvement in acute phase DIC scores, FDP levels, D-Dimer, fibrinogen and platelet counts during rhsTM treatment, but no improvement was observed in patients who died. No serious adverse events were found up to 28 days after the start of rhsTM administration. In conclusion, this study showed no adverse events of rhsTM, and further studies are needed to confirm that rhsTM administration is an effective therapeutic modality in the management of DIC after cardiovascular surgery.

Constrictive pericarditis after open heart surgery is a rare entity that is difficult to diagnose. There are various approaches in the surgical treatment of pericarditis. We performed a pericardiectomy on cardiopulmonary bypass via a median approach with good results. A 67-year-old man underwent mitral valve repair in 2005. He began to experience easy fatigability as well as leg edema beginning in January 2010 for which he was treated medically. The fatigability worsened in July 2012. Echocardiography at that time was unremarkable. However, CT and MRI showed pericardial thickening adjacent to the anterior, posterior, inferior, and left lateral wall of the left ventricle. Bilateral heart catheterization revealed dip and plateau and deep X, Y waves as well as end-diastolic pressure of both chambers approximately equal to the respiratory time. He was diagnosed with constrictive pericarditis and taken to surgery. The chest was entered via median sternotomy and cardiopulmonary bypass was initiated to facilitate complete resection of the pericardium. The left phrenic nerve was visualized and care was taken to avoid damage to the structure. A part of the pericardium was strongly adherent to the epicardium. We elected to perform the waffle procedure. After pericardial resection, cardiac index improved from 1.5 l/min/m² to 2.7 l/min/m², and central venous pressure improved from 17 to 10 mmHg. Postoperatively, dip and plateau disappeared as measured via bilateral heart catheterization and diastolic failure improved. In the treatment of constrictive pericarditis, we should resect as much of the pericardium as possible. Depending on the case, this can be facilitated by median sternotomy and cardiopulmonary bypass.

Early surgical resection for cardiac myxoma is necessary because it may frequently cause cerebral infarction. However the optimal surgical timing for the disease is controversial because the acute phase of infarction may induce intracranial hemorrhage. An 82-year-old woman referred to our hospital because of unconsciousness and right hemiparesis. MRI showed infarction in the left middle cerebral artery area and UCG revealed a left atrial mass. The fourth day after the onset, brain CT showed hemorrhagic infarction and MRI showed new infarction. There was no enlargement of the hemorrhagic focus on brain CT and the patient underwent surgery on the fifth day after the onset. The postoperative course was uneventful. Despite the existence of hemorrhagic infarction, open heart surgery may save patients with cerebrovascular event.

The purpose of this study was to investigate characteristics of past injuries of female university soccer players in comparison with injuries in male university soccer players.
We investigated past injuries of female players (n=32) and male players (n=24) . A past injury was defined as any injury sustained during soccer that required admission to a team doctor, medical attention or absence from practices or games for more than seven days.
The most frequent injury was Joint Injuries in both female and male players. High occurrence of overuse injuries of lower leg was most apparent in the female players. The 32 female players had experienced 144 injuries, or 4.5 injuries per player, and the 24 male players had suffered 85 injuries, or 3.5 injuries per player. The numbers of injuries per player of female players were 1.3 times higher than the male players. Also, the incidence of injury was 0.64 (injury/player/year) in female players, and 0.27 (injury/player/year) in male players. The incidence of injury of female players was significantly larger than that of male players.
We conclude that the prevention and care of overuse injuries in lower leg is very important for female succor players.

Objective: To examine the potent of water as a solvent agent in the preparation of traditional herbal medicine.
Methods: Water extracts of 18 plants were prepared through reflux and examined (25 mg/mL) to evaluate their possibility for inhibiting protein tyrosine phosphatase 1B (PTP1B). The determination of IC50 values was performed for the samples possessing more than 80% inhibition. Meanwhile, those exhibiting IC50 values more than 7.0 mg/mL were further profiled for their chemical constituents through nuclear magnetic resonance (NMR) measurement.
Results: About 44% (8) of the examined samples showed more than 80% inhibition against PTP1B. The water extracts of Elephantopus scaber, Helicteres isora aerial parts, Elaeocarpus grandiflorus (E. grandiflorus) fruits, Melaleuca leucadendron leaves, and Quercus infectoria gum had IC50 values ranging from 2.05 to 6.90 mg/mL. Meanwhile, Andropogon nardus and Centella asiatica were at the area of d 3.0–4.0 ppm. Further, the 13C NMR observation of samples possessing the most intensive signals in their proton NMR Cinnamomum burmannii and E. grandiflorus showed the peaks at the area of d 60–90 ppm as the supportive evidence for sugar group signals. Intriguingly, a disaccharide from E. grandiflorus could be an active inhibitor towards PTB1B.
Conclusions: In contrast to the mainstream solvents currently used in modern herbal manufactures especially Jamu medicine in Indonesia, pure-water-extracted materials should be reconsidered and could be reemerged for future studies and for the manufacture of herbal medicines. In addition, the activity of Jamu components should be confirmed that their antidiabetes and antiobesity activities could be through the inhibition of PTP1B.

Abdominal Injuries ; complications ; Abdominal Wall ; pathology ; Aged ; Embolization, Therapeutic ; Female ; Hematoma ; therapy ; Humans ; Liver Cirrhosis ; complications

A 61-year-old man underwent percutaneous coronary intervention (PCI) for the right coronary artery. However, he had an acute onset of right neck pain and swelling after PCI. Contrast enhanced computed tomography (CT) revealed extravasation into the mediastinum and aberrant right subclavian artery. After transfer to our hospital, we performed emergency endovascular repair for iatrogenic arterial injury. His postoperative course was uneventful.